摘要
目的观察采用异丙酚和芬太尼双通道开环靶控输注(OLTCI)和闭环靶控输注(CLTCI)进行麻醉诱导时,患者血流动力学的变化。方法选择24例施行甲状腺手术的女性患者(ASAⅠ～Ⅱ级),随机分为OLTCI组和CLTCI组(n=12)。OLTCI组以靶控浓度3μg/mL异丙酚和3ng/mL芬太尼分别行麻醉诱导和维持;CLTCI组分别以脑电双频指数(BIS)值和心率(HR)与收缩压乘积为反馈指标行双通道CLTCI,异丙酚和芬太尼起始靶控浓度分别为3μg/mL和3ng/mL,递增或递减浓度分别为0.5μg/mL和0.5ng/mL,最高靶控浓度分别为6μg/mL和5ng/mL。于不同时间点分别记录两组的心率(HR)、平均动脉压(MAP)、心率变异性、BIS值的变化以及异丙酚和芬太尼的用药量。结果CLTCI组:插管后1min和模拟切皮刺激后1min记录的BIS值有所升高,但升高幅度均小于OLTCI组,且控制在64以内(分别为58.9±1.1和59.9±4.1)。与插管前相比,两组在插管后1min记录的MAP均有所升高,但OLTCI组的升高幅度明显大于CLTCI组(P<0.05)。两组的芬太尼总用药量无明显差异,OLTCI组异丙酚总用药量大于CLTCI组。结论与OLTCI比较,以BIS和HR与收缩压乘积作为反馈指标行异丙酚和芬太尼双通道CLTCI能更好地维持稳定的血流动力学和麻醉深度。
Objective To observe the hemodynamic effects of open-loop target controlled infusion （OLTCI） and closedloop target controlled infusion （CLTCI） of propofol and fentanyl for general anesthesia induction. Methods Twenty-four female patients with ASA grade Ⅰ-Ⅱ who were performed thyroidectomy were randomly allocated into two groups： OLTCI group and CLTCI group（ n =12）. In OLTCI group, anesthesia induction and maintenance were performed with propofol and fentanyl at the target concentrations of 3 μg/mL and 3 ng/mL, respectively. In CLTCI group, double CLTCI were performed. Titrations of propofol and fentanyl were guided with bispectral index （BIS） and product of systolic pressure and heart rate （HR）. Initiative concentrations of this closed-loop system were 3 μg/mL and 3 ng/mL, step-up or step-down concentrations were 0.5 μg/mL and 0.5 ng/mL, and the highest concentrations were 6 μg/mL and 5 ng/mL, respectively. HR, mean arterial pressure （MAP） , HR variability, BIS value and the dosages of propofol and fentanyl in various time of the two groups were recorded. Results One min after intubation and simulative incision stimulation, BIS value of both groups were increased, but the BIS value in CLTCI group was less increased than OLTCI group（P 〈0.05）. Both values of BIS in CLTCI group were less than 64（58.9 ±1.1 and 59.9 ±4.1, respectively）. One min after intubation, although MAP of both groups were increased, the increased amplitude of MAP in OLTCI group was significantly higher than CLTCI group （P 〈0.05）. At the endpoint of this experiment, there was no significant difference in the total dosage of fentanyl between the two groups, however, the total propofol dosage was significantly higher in OLTCI group than CLTCI group. Conclusion The double closed-loop system may provide more steady hemodynamic and anesthesia level than the open-loop system during general anesthesia induction.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2008年第2期189-191,共3页
Journal of Shanghai Jiao tong University:Medical Science
关键词
异丙酚
芬太尼
闭环靶控输注
脑电双频指数
propofol
fentanyl
closed-loop target controlled infusion
bispectral index
